Integrating Innovative Approaches To Dementia Care Into Traditional Healthcare Models

The CHRONIC Care Act was passed by lawmakers in early 2018.Norman Z, Creative Commons

In this article in my series on dementia care, I want to focus on how government and healthcare leaders can integrate innovative approaches to dementia care into traditional models of care.

This is often a challenge, especially when we talk about nonmedical approaches. These include many of the approaches discussed in my previous articles, like environmental modifications and new technologies. The challenges range from operational complexities to regulatory challenges, and everything in between. Healthcare regulators need to determine the standards by which nonmedical approaches are approved. Healthcare leaders need to determine how best to implement these approaches in the often highly fragmented healthcare space. And healthcare payers and policymakers need to collectively determine how to cover costs. To fully integrate these new approaches, we need a change in the culture of care.

There are examples of this being done. One of the latest comes from here in the United States, in one of the most complicated and most highly regulated healthcare systems in the world. Earlier this year, a new CHRONIC Care Act was enacted. CHRONIC stands for Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care and it affects some Medicare plans. Medicare is the public health insurance program that covers Americans sixty five and older and all Americans with disability status. Medicare Advantage is one of the plans offered by the public health insurer.

Prior to the CHRONIC Care Act being enacted, supplemental benefits covered by Medicare Advantage plans were restricted to a narrow group of health related services. Any service covered by Medicare Advantage had to be designed to “prevent, cure or diminish an illness or injury.” This meant that nonmedical approaches, like modifying homes to promote autonomy among those living with dementia or installing new monitoring technologies to help caregivers who want to check on loved ones from afar, would not be covered by the insurance program.

The CHRONIC Care Act fundamentally shifts what is covered by the plan. Now, any services that offers “a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee.” The benefits are no longer strictly tied to primarily health related benefits. This means that environmental modifications, such as a raised toilet seat or grab bars beside the toilet, would qualify as a Medicare benefit.

New monitoring and assisted living technologies would also be covered. For a person living with dementia, being able to remain in their home and to follow lifelong routines is possibly the greatest form of freedom and autonomy. Thanks to today’s technologies, people living with dementia can overcome the hurdles of living at home as dementia progresses. Therapeutic robot companions can provide emotional support and help stave off loneliness. Remote monitoring technologies allow family members to check in on their loved ones regularly and automatically monitor potential dangers, such as stoves being left on too long.

The decision to allow these nonmedical approaches to be covered by Medicare Advantage is important, but it doesn’t guarantee integration. As authors from the Johns Hopkins Bloomberg School of Public Health recently wrote in the New England Journal of Medicine: “These changes…have the potential to substantially affect risk selection in Medicare Advantage plans, which may derail progress on integration of medical and non medical care.” The authors warn that administrators of Medicare Advantage plans may decline to broaden their benefit packages to cover nonmedical long term services, which would stall progress even further.

While the impact of the changes enacted by the CHRONIC Care Act are yet to be fully understood, what this shows us is that integrating innovative approaches to dementia care into traditional healthcare models can work and can be done in even the most highly regulated of healthcare settings. My hope is that this article and my previous articles in this series demonstrate the proven strategies than can and should be applied when caring for people living with dementia. These practices were identified based on a series of interviews with dementia care providers here in the United States and in Europe. I invite you to read the full transcripts of those interviews on our website.

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